ORIGINAL ARTICLE
QUANTIFICATION OF PROTEINURIA IN PRE ECLAMPSIA USING
PROTEIN AND CREATININE RATIO IN RANDOM URINE SPECIMEN
R. Padmaja1, M. L. Rajeshwari2, Swetha3
HOW TO CITE THIS ARTICLE:
R. Padmaja, M. L. Rajeshwari, Swetha.”Quantification of Proteinuria in Pre Eclampsia using Protein and
Creatinine Ratio in Random Urine Specimen”. Journal of Evidence based Medicine and Healthcare; Volume
2, Issue 21, May 25, 2015; Page: 3165-3181.
ABSTRACT: Hypertensive disorders complicating pregnancy are common and form one of the
deadly triad along with haemorrhage and infection that results in much of the maternal morbidity
and mortality related to pregnancy. Proteinuria is essential for the diagnosis of preeclampsia. As
the Proteinuria increases, the likelihood of complications also increases and hence a rapid and
accurate detection and quantization of Proteinuria is essential for the management of
hypertensive pregnant women. The protein creatinine ratio in a single urine specimen has been
used for the rapid and accurate detection of proteinuria in hypertensive pregnant women as it
avoids collection errors and gives physiologically more relevant information. OBJECTIVES OF
THE STUDY: To study the clinical profile of preeclampsia patients. To assess the degree of
Proteinuria by 24 hour urine protein and spot urine protein Creatinine ratio in the study
population To study if the spot urine protein and creatinine ratio will provide accurate
quantification of proteinuria in hypertensive pregnant women. MATERIALS AND METHODS:
This was observational study it was conducted in King George Hospital for a period of one year &
60 patients were included for the study. RESULTS: In the present study: spot urine p/c ratio
sensitivity 100%, specificity 66.67%, and positive predictive value of 98.27% added.
CONCLUSION: quantization of proteinuria, when properly interpreted, can provide valuable
information.
KEYWORDS: Pre-eclampsia, Protein creatinine ratio, Maternal morbidity, Infection haemorrhage.
INTRODUCTION: In pregnancy Proteinuria is detected and measured either by visual dipstick
urine analysis or by the 24 hrs urinary protein measurement. The visual dip stick urinalysis in
recent studies has been found to be inaccurate, giving a high number of false positives and false
negatives. The 24 hrs. Urinary collection has been the standard in most places for quantifying
Proteinuria. Though a reliable indicator, it has the disadvantage of being a cumbersome and time
consuming process, for both the patient and laboratory; it is subjected to collection error;
requires good patient compliance and there is a delay of 24 hrs from the time of collection till the
diagnosis is made. Hence, there is a need to evaluate other tests which can be used to quantify
the Proteinuria accurately and rapidly and at the same time overcome the limitations of the
routinely performed tests.
MATERIALS AND METHODS: This observational study was conducted in King George Hospital
for a period of one year where 60 patients were included for the study who are attending
antenatal clinic, between October 2012 and October 2013.
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Inclusion Criteria: Pregnant women with pre eclampsia. Were included for the study.
Exclusion Criteria: Pre-existing renal disorder patients were excluded from the study.
PROCEDURE: All the patients satisfying the above criteria were selected for the study. The tests
were carried out in hospitalized, non-ambulatory patients.
1. A detailed history was taken, general physical and systemic examination including the
Obstetric examination. Per speculum examinations were done to look for any evidence of
vaginal infection clinically.
2. If urine microscopy suggested the presence of infection a urine culture was done.
3. A qualitative test for urinary protein was carried out on a random sample of urine using the
dipstick method. Protein by the dipstick method was graded as follows: Traces = 300 mg/ dl
1+ = 500 mg/dl 2+ = 1gm/dl 3+ = 2gms/dl 4+ = 3gms/dl.
4. The test was repeated on an additional sample of urine immediately and if the subsequent
tests showed 1+ or more, quantitative tests for proteinuria were carried out.
5. The tests were carried out as follows: The patients were instructed to collect the 24 hours
urine starting from the second urine sample in the morning (i.e.; after discarding the first
morning specimen) till the first urine sample the next day morning. A single voided urine
specimen was obtained soon after the 24 hour urine collection, before midday.
6. The samples were sent to the Biochemistry laboratory where:
a) Urine protein was measured by the UCFP method (Urinary-Cerebrospinal fluid protein),
which is an adaptation of the pyragallol red molybdate method. The test was
performed on an automated analyser.
b) Urine creatinine was measured by the CREA method which is a modification of the
Jaffe’s reaction. The test was performed on an automated analyser 46yt.
7. The urine protein and creatinine ratio was obtained by dividing the urine protein
concentration (mg /dl) by the urine creatinine (mg/dl).
8. Normal values for protein excretion:
The data thus collected were analyzed using appropriate statistical methods. The mean and
standard deviations were computed. The statistical test used for analysis were
• Pearson's Correlation Coefficient which is expressed as-r.
• A value of p < 0.05 has been considered to be statistically significant.
Patients were categorized as severe preeclampsia if any of the following criteria were
met:
• Diastolic BP>/=110mmHg or higher.
• Proteinuria persistent >/= 2+.
• Headache, vomiting, epigastric pain, visual disturbances, brisk deep tendon reflexes,
oliguria, presence of IUGR.
• Raised liver enzymes, thrombocytopenia, raised serum creatinine.
Mild pre eclampsia was a BP > = 140/90 and <150/100 mmHg with 1+ protein by Dipstick.
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INVESTIGATIONS:
• HB%, PCV, platelet count.
• Liver function tests –SGOT, SGPT, ALP, serum bilirubin.
• Renal function tests-Blood urea, serum creatinine, serum uric acid.
• Oral GTT.
• Urine albumen/sugar/microscopy.
• 24 Hrs urine protein.
• Spot protein /creatinine ratio.
• Dipstick urine protein.
• Bleeding time/ clotting time, -HIV/HBsAg, -BGT & typing.
RESULTS: The baseline characteristics of the study population is as follows;
Severity
Mild preeclampsia
Severe pre eclampsia
Total
Frequency
22
38
60
37%
63%
100%
Table 1: Distribution of preeclampsia subjects based on severity
In our study 22 (37%) had mild preeclampsia and 38(63%) had severe preeclampsia.
Graph 1
24 hrs urine protein
<300 mg in 24 hrs
300-400mg
>2000 mg
SPOT urine p/c ratio
<0.3
0.3-3
>3
No. of patients
3
45
12
Percentage
5
75
20
2
51
7
3
85
12
Table 2: Distribution of subjects based on degree of proteinuria
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In our study, 3 patients (5%) had proteinuria <300mg, 45(75%) had proteinuria between
300-2000mg and 12(20%) had proteinuria >2000mg based on gold standard test 24hour protein
compared to spot p/c rati, 2 pts (3%) had p/c ratio <0.3, 51pts (85%) had p/c ratio 0.3-3, and 7
pts (12%) with p/c ratio >3.
24 hour urine protein:
Graph 2
SPOT URINE P/C RATIO:
Graph 3
Mild pre eclampsia Severe pre eclampsia
N
Primi
13(31%)
29(69%)
42(70%)
Multi
9(50%)
9(50%)
18(30%)
Total
22
38
60
Table 3: Parity distribution of subjects
In our study it was observed that the incidence of preeclampsia was higher in
primigravidas 42(70%) than in multigravidas 18(30%).
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Graph 4
Age in years Mild pre eclampsia Severe pre eclampsia
Total
<20
3
14
17 (28%)
21-30
18
24
42 (70%)
>30
1
0
1(2%)
Total
22
38
60
Table 4: Age distribution of subjects
It was observed that among 60 subjects studied; majority 42 (70%) of them were in the
age group of 21-30 years. In patients with age <20 years 82% had severe preeclampsia.
Graph 5
Gestational age
in weeks
<28
28-32
32-36
36-40
>40
Total
Mild pre
eclampsia
6
13
3
22
Severe pre
eclampsia
1
2
6
27
2
38
Total
1(2%)
2(3%)
12(20%)
40(67%)
5(8%)
60
Table 5: Distribution of subjects based on period of gestation
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Graph 6
Out of 60 subjects studied, majority of 40 (67%) were in the gestational age of 36-40
weeks. Severe preeclampsia was also found to be the most common in this period of gestation 27
cases (68%).It was observed that the earlier the onset of disease in pregnancythe more severe it
is.
Mode of delivery
FTNVD -33(55%)
Spontaneous –
Induced PretermVD 5(8%)
Spontaneous
Induced
C S. –22(37%)
Mild pre eclampsia
17
10
7
1
1
0
4
Severe pre eclampsia
16
3
13
4
0
4
18
Only severe PE -6
Severe PE associated abruption-2
Post c/s PROM 2
CPD -2
Indication for C/S
CPD -1
Fetal distress -4
GDM and Hypothyroid -1
Breech -1
PROM -1
Post C/S -2
Table 6: Distribution of subjects based on mode of delivery
Of the 60 subjects 22(37%) of them undergone caesarean section, commonest indication
being severe preeclampsia and associated fetal distress.5 (8%) of subjects had a preterm
delivery.
Graph 7
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Birth weight in kg Mild pre eclampsia Severe pre eclampsia Total
<1 kg
1
1
1-1.5 kg
4
4
1.5-2 kg
4
9
13
2-2.5kg
8
12
20
2.5-3 kg
9
9
18
>3kg
1
3
4
Table 7: Distribution of subjects based on fetal outcome birth weight
Graph 8
Of the 60 subjects delivered at our hospital, 33% had birth weight between 2-2.5 kgs, one
baby was still born and 3 babies died in IPCU in view of low apgar and preterm.The perinatal
outcome in women with severe preeclampsia was poor with increased incidence of
IUGR, LBW, preterm births, meconium stained liquor and requiring higher need for NICU
admission.
Apgar score Mild pre eclampsia Severe pre eclampsia
8-10
19
14
6-8
3
20
<6
4
Part B: Apgar score at birth
Graph 9
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Liquor
Mild pre eclampsia Severe pre eclampsia
Clear
19
21
Meconium stained
3
15
Blood stained (abruption)
2
Other
Oligamnios
2
polyhydramnios
1
Part C: State of liquor
NICU admission Mild pre eclampsia Severe pre eclampsia
Not admitted
18
14
Admitted
4
24
Causes;
Meconium
2
11
Low apgar
3
LBW
2
4
IUGR
4
Preterm
2
Part D: N.I.C.U admission
Graph 10
Live Still born Dead
Severe pet 34
1
3
Mild pet
22
Part E: Fetal outcome
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Graph 11
Mild pre eclampsia
Severe pre eclampsia
Anemia-1
Anemia – 1
GDM and Hypothyroid -1
Post ASD -1
GDM-1
Rh –ve 2
Jaundice -1
Jaundice -1
Blood transfusion -1
Antepartum eclampsia -4
Platelets -1
Post-partum eclampsia -3
h/o blood transfusion -4
platelets -2
FFP -1
Table 8: Associated medical conditions
Of the 60 patients with preeclampsia, 7 patients developed eclampsia, 2 patients had
abruption and 2 cases developed partial HELLP syndrome.
Variable
Mean
Standard deviation
24 hrs urine protein
1645.72/24 hrs
2098.43
Spot urine protein ceatinine ratio
1.991
2.463
Table 9: Correlation coefficient between 24 hour urine
protein and spot urine protein creatinine ratio
Correlation coefficient r = 0.906 (pvalue<0.001).
For n number of subjects n = 60.
Degree of freedom =n-2 =58.
At 58 degrees of freedom table value =0.408 at p value<0.001, and observed value
=0.906.
It implies that there is a good correlation between 24hrs urine protein and spot urine
protein creatinine ratio which is significant at p value <0.001 in 60 patients with preeclampsia.
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Graph 12
This graph shows the distribution of 24hr random urine protein and spot urine protein
creatinine ratio in patients with preeclampsia.
The central line is the best fit due to regression. The overall correlation coefficient (r)
between 24 hrs urine protein and spot protein creatinine ratio r = 0.906 at p value<0.001,
1. When 24 hour urine protein values were <3gms, spot p/c ratio values were <3- in the
above graph all the observations are clustered around this range which has a good
correlation coefficient of r =0.641 with p value <0.001.
2. When 24 hour urine protein values were >3gms, spot p/c ratio values were along the line
but not clustered, the correlation coefficient r =0.88 at value <0.01,it implies that even at
higher ranges of proteinuria though significance decreases, a fair correlation exists between
24 hour urine protein and spot p/c ratio.
24 hrs urine protein
>3gm
<3gm
>2gm
<2gm
300-2000gm
<300mgs
N Correlation coefficient r P value
7
0.88
<0.01
53
0.641
<0.001
12
0.885
<0.001
48
0.536
<0.001
45
0.494
<0.001
3
-0.87
>0.1
In the present study it was observed that with proteinuria <300 mg a negative correlation
exists between 24 hour urine protein and spot p/c ratio. This observation can be explained by the
fact, that, the numbers of patients in this range of proteinuria are less and also in the exclusion
criteria those patients with dipstick <1+ (like traces and negative) is excluded from the study.
Mild pre eclampsia n=22
Mean Standard deviation
24 hr urine protein
745.18
425.118
Spot urine protein creatinine ratio
.845
0.48
Severe pre eclampsia n=38
24 hr urine protein
2167.1
2481.2
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Spot urine protein creatinine ratio
2.65
2.84
Table 10: Correlation coefficient between 24 hour urine protein
and spot urine protein creatinine ratio based on severity
Severity
R
P VALUE
Mild pet n=22
.801
<.001
Severe pet n=38 .895
<.001
Correlation co-efficient R
a) For n number of subjects with mild preeclampsia n=22.
Degree of freedom=n-2=20.
At 20 degrees of freedom table value =0.652 at pvalue<0.001, and observed value
=0.801.
It implies that there is a good correlation between 24hr urine protein and spot urine
protein creatinine ratio which is significant at p value <0.001 in 22 patients with mild
preeclampsia.
b) For n number of subjects with severe preeclampsia n=38.
Degree of freedom=n-2=36.
At 36 degrees of freedom table value =0.519 at pvalue<0.001, and observed value
=0.895.
It implies that there is a good correlation between 24hrs urine protein and spot urine
protein creatinine ratio which is significant at p value <0.001 in 38 patients with severe
preeclampsia.
Graph 13
This graph shows the distribution of 24hr random urine protein and spot urine protein
creatinine ratio in patients with severe preeclampsia. Considering 24hour urine protein as gold
standard test 24 hour urine protein.
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Spot p/c ratio +ve>300mg _ve<300mg
+VE>.3
57 TP
1 FP
_ve<.3
0 FN
2 TN
Sensitivity of Spot urine P/C ratio-100% (A/A+C)*100.
Specificity of spot urine p/c ratio-66.67% (D/B+D)*100.
Positive predictive value of spot p/c ratio-98.27% (A/A+B)*100.
Graph 14
24hrs urine protein.
Spot urine protein creatinine ratio.
Severe preeclampsia.
No. of cases
Mean age in yrs
Mean pog in weeks
No of primi
No of multi
Mean Hb
platelets
Blood urea
Serum Creatinine
Serum Uric Acid
Elevated Left
Grade 1 Fundus- HTN
Mean Systolic Blood Pressure (mmHg)
Mean Diastolic Blood Pressure (mmHg)
Mean spot urine protein creatinine ratio
Mean 24 hr urine protein
Correlation ratio
P value
FTNVD
PTNVD
Mild pet Severe pet Total
22
38
60
24
23
23.1
38
37.4
37.7
13
29
42
9
9
18
9.06
95
9.34
2.02
1.91
1.95
21.5
23.46
22.93
0.754
0.93
0.87
4.55
5.9
5.41
8
8
3
3
140
161.84
155.7
90
113.42
104.67
.845
2.65
1.99
745.18
2167.7
1645.72
.801
.895
.96
<.001
<.001
<.001
17
16
33
1
4
5
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CAESAREAN SECTION
4
NO of IUGR cases
5
Mean birth wt in kgs
2.55
Meconium liquor
3
NICU admission
4
LIVE
22
Still birth
dead
Table 11: Summary
18
15
2.272
15
24
34
1
3
22
20
2.37
18
28
56
1
3
No. of cases of IUGR
20
Primi
14
Multi
6
Severe pet
15
Mild pet
5
Mean age
23.7yrs
POG
37.75 wks
Systolic BP
159mmHg
Diastolic BP
109mmHg
Blood urea
24.75mg/dl
Serum creatinine
.945mg/dl
Serum uric acid
5.86mg/dl
Hb%
9.23g
Platelet count
1.97 lacs
Spot urine protein creatinine ratio
2.819
24 hr urine protein
2287mg/24 hrs
Correlation ratio
.95
P value <0.001
Birth weight
1.93
Elevated LFT
5
Grade 1 fundus
2
Table 12: IUGR in preeclampsia
Number of patients with preeclampsia associated with IUGR n=20.
Degree of freedom = n-20 =18
At 18 degrees of freedom table value=0.665 with p value <0.001: observed value =0.95.
It implies that the correlation ratio between 24hr urine protein and spot urine protein ratio
is highly significant at p value <0.001 in patients with preeclampsia associated with pre
eclampsia.
ANALYSIS: An accurate and rapid detection and quantification of proteinuria are essential in the
management of hypertensive disorders in pregnancy. This can help us know the severity of
proteinuria much earlier and hence the severity of the disease process, which can alter the course
of management. In the present study of 60 preeclamptic women, the mean age of the patients
was 23.1 years and the mean gestational age was 37.7 weeks. 22 (37%) had mild preeclampsia
and 38(63%) had severe preeclampsia, 3 patients (5%) had proteinuria <300mg, 45(75%)
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hadproteinuria between 300-2000mg and 12(20%) had proteinuria >2000mg based on gold
standard test 24hour urine protein compared to spot p/c ratio, 2 pts (3%) had p/c ratio <0.3,
51pts (85%) had p/c ratio 0.3-3, and 7 pts (12%) with p/c ratio >3.The incidence of
preeclampsia was higher in primigravidas 42(70%) than in multigravidas 18(30%), majority 42
(70%) of them were in the age group of 21-30 years. In patients with age <20 years 82% had
severe preeclampsia. It was observed that, 40 patients (67%) were in the gestational age of 3640 weeks. And severe preeclampsia was a found to be the most common in this period of
gestation 27 cases(68%).It was also observed that the earlier the onset of disease in pregnancy,
the more severe it is. The overall correlation coefficient (r) between 24 hrs urine protein and spot
protein creatinine ratio r=0.906 at p value<0.001.Of the 60 subjects 22(37%) of them underwent
Cesearean section, the commonest indication being severe preeclampsia and associated fetal
distress. 5(8%) of subjects had a preterm delivery. Of the 60 subjects delivered at our hospital
33% have birth weight between 2-2.5 kgs, one baby was still born and 3 babies died in IPCU in
view of low apgar and preterm. The perinatal outcome in women with severe preeclampsia was
poor with increased incidence of IUGR, LBW, preterm births, meconium stained liquor and
requiring higher need for NICU admission. Of the 60 patients with preeclampsia, 7 patients
developed eclampsia, 2 patients had abruption and 2 cases developed partial HELLP syndrome.
The study was limited to hospitalized non ambulatory patients. Since the protein excretion
is affected by postural change, being higher in the standing than in supine position, the
ambulatory status of the patients is important while interpreting the results. We found a good
degree of correlation in our study, when the 24 hours urine protein and the random urine
protein-creatinine ratios were correlated with r=0.906 and the p value being highly significant at
<0.001, when all the observations were considered.
The correlation was also found to be good at r = 0.641 and p<0.001, for lesser degrees of
proteinuria < 3 gms/24 hours and protein/ creatinine ratio also < 3. But when the correlation was
computed for higher degrees of proteinuria i.e.; > 3gms/24 hrs, there was a fair correlation with
r=0.88 and p value being <0.01 which is statistically significant but to a lesser degree than
proteinuria <3 gms/24 hours. In a similar study conducted by Jaschevatzky et al in 1990, the
Degree of correlation between the two variables at >2gms/ 24 hrs proteinuria was lower but still
significant at p <0.05.
Study
Correlation co-efficient R P value
Ginsberg et al
.93
<.001
Neithardt et al 2000
.93
<.001
Robert et al
.94
<.001
Boler et al
.99
<.001
Sauden et al
.93
<.001
Young et al
.80
<.001
Jaschevatsky et al 1990
.92
<.001
Shahbazian 2008
.84
<.001
Bansal bhavna 2009
.83
<.001
Present study
.906
<.001
Table 13: Comparison of present study with similar studies
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All of the previous studies demonstrate an excellent correlation between the 24 hrs urine
protein and the protein/ creatinine ratio. The p values are also statistically very significant at
<0.001 which is also seen in our study. We have found the use of this alternative test to 24 hours
urine protein to be much more cost effective as shown with many studies previously. We have
also found the 24 hours urine collection to be cumbersome and inconvenient for a pregnant
woman. Since the present study included women only with a stable renal function, our study
supports the use of the protein/creatinine ratio in women with normal to mildly impaired renal
function (<1.6mg %). The mean serum creatinine value in our study group was 0.87mg/dl. But
Robert et al in 1997 and Quadri et al in 1994 have proved in their studies that the
protein/creatinine ratios are independent of renal function and reliable even in the presence of
underlying renal disease and have advocated their use to monitor renal function in pregnancy.
In our study results were:
• The overall correlation coefficient (r) between 24 hrs urine protein and spot protein
creatinine ratio r = 0.906 at p value <0.001.
a) When 24 hour urine protein values were <3gms, spot p/c ratio values were <3- as
shown in the graph all the observations are clustered around this range which has a
good correlation coefficient of r =0.641 with p value <0.001.
b) when 24 hour urine protein values were >3gms, spot p/c ratio values were along the
line but not clustered, the correlation coefficient r =0.88 at p value <0.01,it implies that
even at higher ranges of proteinuria though significance decreases, a fair correlation
exists between 24 hour urine protein and spot p/c ratio.
• In the present study it was observed that with proteinuria <300 mg a negative correlation
exists between 24 hour urine protein and spot p/c ratio. This observation can be explained
by the fact, that, the number of patients in this range of proteinuria was less and also in the
exclusion criteria those patients with dipstick <1+ (like traces and negative) is excluded
from the study.
Hence care should be taken while interpreting the protein/ creatinine ratios at severe
degrees of Proteinuria.
DISCUSSION: Pre eclampsia is a major cause of maternal mortality& morbidity, perinatal
deaths, pre term birth and IUGR.1,2,3,4,5
The main pathology in PIH is reduced concentration of angiogenic growth factors and
increased placental debris in maternal circulation resulting in a(mainly hypertensive) maternal
inflammatory response.1
PET may be seen as a 2 stage Disorder: Stage 1 – poor placentation (early) and stage 2 –
placental oxidative stress (late) leading to 1 fetal growth restriction 2 systemic release of
placental factors - systemic inflammatory response - endothelial activation - pre eclampsia
syndrome 4.
The optimal method of establishing either abnormal levels of urine protein or albumin
remains to be defined. Dipstick qualitative determination depends upon urinary concentration and
may give false positive and false negative results. For 24 hrs quantitative specimen the standard
consensus is > 300mg.1,2,3,4,5.
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Determination of threshold value of urinary protein and albumin, creatinine ratio may
supplement the cumbersome 24 hrs quantification. Papanna and associates in 2008 concluded
that random urine protein creatinine ratios <130-150 or from 0.13 to 0.15 indicate that the
lielihood of proteinuria >300 g/day is low.
+Newly available test kits permit rapid measurement of urinary albumin creatinine ratio in
an OPD setting (Kyle). In non-ambulatory hypertensive patients there is a strong correlation
between random voided protein creatinine ratio and 24 hrs urine protein excretion.6
Placental soluble fms like Tyrosine kinase, an antagonist of VEGF and placental growth
factor is up regulated in pre eclampsia. It is suggested that excess circulating SFLT 1 contributes
to the pathogenesis of pre eclampsia.7
There is excellent correlation between CG formula using pre pregnancy weights and 24 hr
creatinine clearance and between P.C and 24 hrs urinary protein. The P.C ratio can be used
instead of cumbersome 24 hrs urine collection to assess protein excretion and creatinine
clearance serially throughout pregnancy.8
One can use a single voided PC ratio in hospitalized pregnant patients to predict the 24 hr
urine result.9
A random protein creatinine ratio provides an accurate and rapid quantitation of
proteinuria in hypertensive pregnant women. This should improve clinical care especially when
managing hypertensive pregnant women as outpatients.10
Since the level of urinary protein excretion has considerable clinical implications in the
course of pregnancy and on the perinatal and maternal outcome, the early detection of even
minor degrees of proteinuria is important. And Dipstick analysis as a screening for proteinuria
lacks reliability with a high rate of false positives.1,2,3,4
For years, 24 hour urine collection has been the standard for quantification of proteinuria
in the management of women with pre eclampsia. However, this method requires good patient
compliance and results in the delay in the diagnosis of >24 hours from the start of collection. Our
contention was that the value of the protein/creatinine ratio in a single urine sample is potentially
more accurate, because it avoids collection errors and may give more physiologically relevant
information. Quantitating proteinuria in a random sample has been found to be far more cost
effective and acceptable to the patient than a 24 hour urine collection. Since pre eclampsia is a
progressive disease, repeated laboratory examinations to quantitate proteinuria are required.
Protein/ creatinine ratio has been found to be a superior diagnostic tool compared to the routine
urinalysis which would otherwise be used for daily quantification of Proteinuria. It is especially
found to be useful in an outpatient setting to predict clinically significant Proteinuria and to
monitor renal functions in such women with lesser degrees of proteinuria thus avoiding
unnecessary hospital admissions. The present study indicates that this method for quantization of
proteinuria, when properly interpreted, can provide valuable information, that for clinical
purposes is a satisfactory substitute for the determination of protein excretion in a 24 hour
collection1,4
CONCLUSION: Pre-eclampsia is associated with complication if not diagnosed in time and
manage properly. To prevent further complication better to get some important investigation
J of Evidence Based Med &Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 21/May 25, 2015
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ORIGINAL ARTICLE
which will give you clue for further detoriation of the disease. Urine for protein creatinine in ratio
is one of the important investigations which will provide you information about progress of the
disease if properly interpreted.
REFERENCES:
1. Sibai B., Dekkar G, Kupfermine M, Preeclampsia, Lancet.2005:365:785-799.
2. Walker Pre Eclampsia Lancet2000 356, 1260-5.
3. Steer J Philip, Weiner Carl, Gonik Bernard, High risk pregnancy management options.
4th edition.600.
4. Cunningham G, Macdonald P, Norman F Gant, Kenneth P Leveno-Williams Obstetrics 23RD
edition. 710-730.
5. Arias Fernando – Practical guide to high risk pregnancy and delivery.3rd edition. 398-400.
6. Magali Robert, Farshad Sepandj, Robert M Liston, Kent C Dooley,-Random Protein
Creatinine Ratio for the Quantitation of Proteinuria in Pregnancy‖, Obstet Gynecol, 1997,
vol. 90: 893-5.
7. Maynard SE, Min JY, Mercham J, etal., Excess placental soluble fms-like tyrosine kinase 1
(SFlt 1) may contribute to endothelial dysfunction, hypertension and Proteinuria in
Preeclampsia, J Clin; 2003-111,649-58.
8. K. H. M. Quadri, J. Bemardini, BSN, A. Greenberg et al,-Assessment of Renal Function
During Pregnancy Using Protein to Creatinine Ratio and Cockroft-Gault formula‖, Am J of
Kidney Diseases, 1994, vol. 24, No.3 (September): 416-20.
9. Adrienne B Neithardt, Sharon L Dooley, Jayne Borensztajn, -Prediction of 24 hour protein
excretion in pregnancy with a single voided urine protein to creatinine ratio‖, Am J Obstet
Gynecol, 2002,vol. 186: 883-886.
10. Patrick J Saudan, Mark A Brown, Tanya Farrell, Loretta Shaw, -Improved Methods of
assessing proteinuria in hypertensive pregnancy‖, Br J Obstet Gynaecol, 1997, vol.
104:1159-64.
AUTHORS:
1. R. Padmaja
2. M. L. Rajeshwari
3. Swetha
PARTICULARS OF CONTRIBUTORS:
1. Assistant Professor, Department of
Obstetrics & Gynecology, Andhra
Medical College, Visakhapatnam.
2. Assistant Professor, Department of
Bio-chemistry, Andhra Medical
College, Visakhapatnam.
3. Senior Resident, Department of
Obstetrics & Gynecology, Andhra
Medical College, Visakhapatnam.
NAME ADDRESS EMAIL ID OF THE
CORRESPONDING AUTHOR:
Dr. R. Padmaja,
Door No. 15-9-4/17,
Plot No. 101,
Sea Scape Apartments, Krishna Nagar,
Maharanipeta, Vizag-530002.
E-mail: rajupadmaja1971@gmail.com
Date
Date
Date
Date
of
of
of
of
Submission: 09/05/2015.
Peer Review: 11/05/2015.
Acceptance: 20/05/2015.
Publishing: 25/05/2015.
J of Evidence Based Med &Hlthcare, pISSN- 2349-2562, eISSN- 2349-2570/ Vol. 2/Issue 21/May 25, 2015
Page 3181